MOPDE0105 - Poster Discussion
Male circumcision in Swaziland: demographics, behaviours and HIV prevalence
Presented by Jason Bailey Reed (United States).
J.B. Reed1, M. Mirira2, J. Grund1, A. Nqeketo3, H. Ginindza3, D. Donnell4, R. Nkambule3, G. Bicego5, C. Ryan6, J. Justman7
1U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of HIV/AIDS, Atlanta, United States, 2USAID Swaziland, Mbabane, Swaziland, 3Ministry of Health - Swaziland, Mbabane, Swaziland, 4Fred Hutchinson Cancer Research Center, Seattle, United States, 5U.S. Centers for Disease Control and Prevention Swaziland, Mbabane, Swaziland, 6Office of the Global AIDS Coordinator, Washington, United States, 7ICAP at the Mailman School of Public Health at Columbia University, New York, United States
Background: In 2006, the estimated prevalence of circumcised men in Swaziland was 8%. Between 2007 and 2011, approximately 35,000 men underwent voluntary medical male circumcision, including 11,000 men circumcised in 2011 during a national HIV prevention campaign, "Soka Uncobe". The Swaziland HIV Incidence Measurement Survey (SHIMS), a nationally representative, household-based survey of men and women in Swaziland, conducted independently from the circumcision campaign, assessed health behaviors and HIV prevalence.
Methods: Between December 2010 and June 2011, SHIMS participants were surveyed about demographic, clinical and behavioral factors, including self-reported circumcision status by men. All participants underwent HIV testing.
Results: Of 18, 212 adults surveyed in SHIMS, 7075 (39%) were men and 16% (1105/7075) were circumcised. Median age at circumcision was 20 y (interquartile range (IQR) 8, 17), median time since circumcision was 1.1 y (IQR 0.6-8.0), and 172 men (16%) reported circumcision in the prior 6 months. Prior HIV testing was more commonly reported by circumcised compared to uncircumcised men (77% vs. 49%, p< 0.001). Circumcised men were slightly more likely than uncircumcised men to report always using a condom in the prior 6 months (39% vs. 33%, p=0.003) and the number of reported sex partners in the prior 6 months did not differ (1.4 vs. 1.5). Circumcised men had a significantly lower HIV prevalence compared to uncircumcised men (14% vs. 24%, PR=0.61, 95% CI=0.52-0.70).
Conclusions: While the prevalence of male circumcision in Swaziland remains low, it has doubled in the past 5 years from 8% to 16%. Circumcised men in Swaziland do not report riskier sexual behavior and are more likely to have been tested for HIV, compared to uncircumcised men. HIV prevalence was significantly lower in circumcised men, reinforcing the evidence for a protective effect of male circumcision provided as a population-level (non-research) intervention.
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